International Journal of Medicine and Data
International Journal of Medicine and Data. 2022; 6: (6) ; 10.12208/j. ijmd.20220261 .
总浏览量: 402
贵州医科大学附属医院肛肠外科 贵州贵阳
*通讯作者： 程海玉,单位：贵州医科大学附属医院肛肠外科 贵州贵阳；
目的 对比分析评价腹腔镜与达芬奇机器人辅助下直肠癌根治手术的近期疗效。方法 对贵州医科大学附属医院肛肠外科在2021年3月~2022年3月期间，实施腹腔镜与达芬奇机器人辅助下直肠癌根治手术的患者资料进行回顾性分析，每组各50位患者，综合对比不同组间的手术时长、出血量、手术清扫淋巴结数目、24 h C-反应蛋白术后水平、肛门术后恢复排气时间、术后尿管保留时长、腹腔引流管术后留置时长、手术后住院时长和手术并发症等指标间的差异。结果 两组直肠癌患者均顺利完成达芬奇机器人或腹腔镜直肠癌根治术，腹腔镜组肿瘤长径0.9~2.2 cm；距离肛缘的中位距离为7cm（5~12cm）；术后环周切缘均为阴性；术中清扫淋巴结中位数14枚（12~18枚）。机器人组肿瘤长径1.0~2.0 cm；距离肛缘的中位距离为8cm（5~12cm）；术后环周切缘均为阴性；术中清扫淋巴结中位数14枚（12~17枚）。相比腹腔镜手术直肠癌患者，机器人组直肠癌患者的手术出血量减少，术后尿管留置时间减少、手术后24 h的C-反应蛋白水平减低，差异存在统计学意义（P<0.05）。腹腔镜组及机器人直肠癌患者，手术时长、术中清扫淋巴结数目、肛门术后恢复排气时间、手术后开始进食流质饮食的时间、腹腔引流管术后留置时长、手术后住院时长、出现吻合口瘘和肠梗阻等其他并发症情况，其差异间都无统计学意义（P>0.05）。结论 相比腹腔镜直肠癌根治术，达芬奇机器人直肠癌根治手术出血量更少、术后炎症反应程度低、盆腔自主神经损伤更轻，具有地域性推广应用的潜力。
Objective To compare and analyze the short-term efficacy of laparoscopic radical resection of rectal cancer and Da Vinci robotic radical resection of rectal cancer. Methods The clinical data of patients who underwent Da Vinci robotor laparoscopassistedradical resection of rectal cancer in our department from March 2021 to March 2022 were retrospectively analyzed. Compared with the operation time, intraoperative blood loss, number of lymph node dissection, postoperative 24h C-reactive protein, postoperative first flatus time, postoperative urinary catheter indwelling time, abdominal drainage tube indwelling time, postoperative hospital stay and postoperative complications between two groups. Result Both groups of rectal cancer patients successfully completed Da Vinci robot or laparoscopic radical resection of rectal cancer, the laparoscopic group of tumor diameter 0.9~2.2 cm; The median distance from the anal margin was 7cm (5-12cm).Postoperative circumferential margins were negative. The median number of lymph nodes dissected during the operation was 14 (12~18).The tumor diameter of the robot group was 1.0~2.0 cm. The median distance from the anal margin was 8cm (5-12cm).Postoperative circumferential margins were negative. The median number of lymph nodes dissected during the operation was14(12~17). The robot group had less intraoperative blood loss, shorter postoperative catheter indent time and lower C-reactive protein 24h after surgery, with statistical significance (P<0.05).There were no significant differences between the two groups in operation time, number of lymph node dissection, time of first anal exhaust after surgery, time of indentation of abdominal drainage tube, time of postoperative recovery of liquid diet, time of postoperative hospital stay, occurrence of anastomotic fistula, intestinal obstruction and other complications (P>0.05).Conclusion Compared with rectal cancerlaparoscopic radical resection, Da Vinci robot radical resection of rectal cancer is safe and feasible, and has less intraoperative bleeding, less inflammatory reaction, and less pelvic autonomic nerve injury, which has the potential for regional promotion and application.
[1] Prete FP,Pezzolla A,Prete F,et al.Robotic Versus Laparoscopic Minimally Invasive Surgery for Rectal Cancer:A Systematic Review and Meta-analysis of Randomized Controlled Trials[J].Ann Surg,2018,267(6):1034-1046.
[2] 于永扬,陈海宁,周总光.我国结直肠癌的现状、制约瓶颈与反思[J].中国普外基础与临床杂志,2019,26(08):897-902.
[3] Feng H,Schiergens TS,Mao ZH,et al.Long-term outcomesand propensity score matching analysis:rectal cancer resection for patients with elevated preoperative risk[J].Oncotarget,2017,8(15):25679-25690.
[4] Yates DR,Vaessen C,Roupret M.From Leonardo to da Vinci:the history of robot-assisted surgery in urology[J].BJU Int,2011,108(11):1708-1713.
[5] Wang L, Zhang Z Gong L, et al. A Systematic Review and Bayesian Network Meta-Analysis: Short-Term and Long-Term Outcomes of Three Surgery Procedures Fol-lowing Neoadjuvant Chem oradiotherapy for Rectal Cancer[J].J Laparoendosc Adv Surg Tech A,2019,29(5):663-670.
[6] Wang L,Zhang Z,Gong L,et al.A Systematic Review and Bayesian Network Meta-Analysis: Short-Term and Long-Term Outcomes of Three Surgery Procedures Following Neoadjuvant Chemoradiotherapy for Rectal Cancer[J].J Laparoendosc Adv Surg Tech A,2019,29(5):663-670.
[7] Yamaguchi T, Kinugasa Y, Shiomi A, et al. Robotic-assisted vs conventional laparoscopic surgery for rectal can-cer:short-term outcomes at a single center[J].Surg Today,2016,46(8): 957- 962．
[8] Pigazzi A, Ellenhorn JD, Ballantyne GH, et al. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer[J].Surg Endosc,2006,20(10):1521-1525．
[9] Baik SH, Kang CM, Lee WJ, et al．Robotic total mesorectal excision for the treatment of rectal cancer[J].J Robot Surg,2007,1 (1):99-102．
[10] Lee SH, Kim DH, Lim SW. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis[J].Int J Colorectal Dis,2018,33 (12 ):1741 -1753．
[11] Jayne D,Pigazzi A,Marshall Hl,et al.Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer:The ROLARR Randomized Clinical Trial[J].JAMA,2017,318(16):1569-1580.
[12] Chen Z,Zhu ZL,Wang P,et al.Comparison of clinical efficacy between robotic-laparoscopic excision and traditional laparoscopy for rectal cancer:A protocol for systematicreview and meta-analysis[J].Medicine (Baltimore),2020,99(27):1-3.
[13] Spinoglio G, Bianchi PP, Marano A, et al. Robotic versus laparoscopic right colectomy with complete mesocolicexcision for the treatment of colon cancer: perioperativeoutcomes and 5-Year survivalin a consecutive series of 202 patients[J]. Ann Surg Oncol, 2018, 25(12):3580-3586.
[14] Tamhankar AS,Jatal S,Saklani A.Total robotic radical rectal resection with da Vinci Xi system:single docking,single phase technique[J].Int J Med Robot,2016,12(4):642-647.
[15] Sun XY,Xu L,Lu JY,et al.Robotic versus conventional laparoscopic surgery for rectal cancer:systematic review and meta-analysis[J].Minim Invasive Ther Allied Technol,2019,28(3):135-142.
[16] Kim J,Baek SJ,Kang DW,et al.Robotic Resection is a Good Prognostic Factor in Rectal Cancer Compared with Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching[J].Dis Colon Rectum,2017,60(3):266-273.